HUB's LIST of medical fun facts

“The specter of a ‘trans epidemic’ is haunting the world.” (1)

According to President-elect Trump the trans epidemic has already come to your town, “The transgender thing is incredible. Think of it: Your kid goes to school and comes home a few days later with an operation.” 

Proponents of this “epidemic theory” point to the increasing number of children seeking “gender-affirming” care and the increasing number of hospitals and physicians offering such care. They think this growing demand for medical transition is a result of the acceptance of non-traditional gender identities encouraged by social media and school and governmental tolerance, eg. the “cultural conflict” of personal pronouns. The increasing demand results from the “social contagion” of trans identities.

The theory of “social contagion” is not new. In 1920 a German psychologist stated that “war and revolution provided the grounds for an almost epidemic spread of inversion [aka homosexuality].” Conversion therapy for homosexuality was a natural result of a belief in “inversion”. BUT, GENDER AND SEXUALITY ARE NOT THE SAME.

                           “Sexual orientation is ‘who you go to bed WITH’, Gender identity is ‘who you go to bed AS’, and they may not be the same.”   (see my Sept.1, 2017 blog)

In 1930 a 47 year old Danish man went to Germany for surgery and successfully became a woman. In 1952 Christine Jorgensen underwent hormonal and surgical treatment in Copenhagen to become a woman. She was treated by the press as a celebrity and role model. Her story prompted over 700 letters from 465 people to her pioneering physician, Harry Benjamin, MD,  asking about “sex change” treatment.

The outpouring of interest in this medical treatment advance produced defensive reactions from governments and physicians. “The construction of a trans epidemic was thus enabled by a broader social concerns about the dissolution of the nuclear family and traditional values and gender norms. Framing requests for medical transition as an epidemic may arouse social anxieties, lead to moral panics, and trigger more political positioning.” (1)  For instance, “social contagion” theories fed by social as well as mainstream media, some governments, and some physicians certainly hampered our rational responses to the true, viral epidemics of AIDS and COVID.

During the past decade trans medicine has advanced, both in hormonal use and surgical procedures, partly in response to the growing awareness of the bad outcomes of gender dysphoria (higher rates of suicide, depression, anxiety, and self-harm). In 2007 the first gender transition center for adolescents  in the U.S. was formed at Boston Children’s Medical Center. Now most medical centers in Boston, and throughout the U.S., have multidisciplinary gender evaluation centers for adolescents. It takes months to complete the medical and social evaluation of adolescents requesting gender transition. It is lengthy, complex, time-consuming, expensive, and involves the whole family and to some extent the patient’s school.

Subsequent medical transition treatment for patients deemed appropriate for it by their evaluation may include timely hormonal treatment to pause or block puberty followed by surgery appropriate to the new gender, often referred to as distinct “top surgery” or “bottom surgery”. Not every trans person who requests evaluation is accepted for medical treatment. Not all of the trans persons accepted for treatment opt for surgery.

In 2022 because of the increasing demand for requests of medical transition evaluation in the U.K. the National Health Service impaneled an independent study group to recommend standards of “gender affirming care” for practitioners and hospitals. It was chaired by a very prestigious pediatrician, Dr. Hillary Cass, and in April 2024 the 388 page “Cass Review” was published. The Cass Review was hailed as an evidence-based rationale in support of providing “gender-affirming care” to adolescents. But, it also recommended NHS restrictions on some treatments, specifically prepubertal hormone therapy to “pause puberty” prior to surgery. The Cass Review restrictive recommendations prompted significant criticism from medical transition care professionals both in the U.S. and Europe.

One such 39 page response from 9 professionals at the Yale Law School and Yale School of Medicine questioned the Cass Review’s data and statistical methodology and soundly criticized its several recommendations restricting some gender-affirming care modalities in the NHS. (2) In the U.K less than 10% of about 44,000 transgender citizens in their 2021 census have requested medical transition evaluation since 2011. Not all, of course, are accepted for medical transition care. The evaluations are “not rushed, careless, or common.” Less than a 1000 U.K. patients are actually on puberty-pausing hormones. In the U.S. less than 2-4% of the people identifying as transgender are receiving puberty-pausing medication.

The Cass Review did explicitly acknowledge that the field of trans medicine is so new that we don’t have any real data on the long term effects of trans medicine treatment.  “If politics continue to interfere with transgender healthcare, clinical services and research in this field may not recover. Peoples’ lives will be drastically—and needlessly—upended. Further, the politicization of healthcare is a concern not just for transgender people, but for all people. Every person deserves the opportunity to make private and deeply personal medical decisions in consultation with healthcare providers whose work is guided by sound evidence, appropriate training, and clinical expertise. “ (2) .

We’ll let Dr. Cass have the last word:
“We’ve let them [children] down because the research isn’t good enough and we haven’t got good data…
The toxicity of the debate is perpetuated by adults, and that itself is unfair to the children who are caught in the middle of it.
The children are being used as a football, and this is a group that we should be showing more  compassion to.” (3)

References:
1.”How the Idea of Social Contagion Shaped Trans Medicine”, NEJM 391:16 October 24, 2024.
2. https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf
3. https://cass.independent-review.uk/wp-content/uploads/2024/04/CassReview_Final.pdf